Reaching more people with existing vaccines

Progress towards measles mortality reduction challenged by resurgence

Major progress has been made in the fight against measles. Global measles mortality declined by an impressive 78% from an estimated 733 000 deaths in 2000 to 164 000 in 2008.

Increased measles vaccination reduced overall under-five mortality by 23% between 1990 and 2008. More than 190 million children were vaccinated against measles through large-scale campaigns in 2010. These campaigns continue to provide a platform for delivering other health interventions. Over 32 million doses of vitamin A, 19 million doses of de-worming medicine, and 9 million doses of polio vaccine were distributed during measles campaigns in 2010.

The Government of India began a phased introduction of a second dose of measles vaccine through vaccination campaigns and in its national immunization programme. China conducted the largest measles vaccination campaign ever, reaching over 100 million children.

2010 was also a challenging year. During measles outbreaks in Africa, over 200 000 measles cases and 1400 deaths were reported. Due to under-reporting, the true number of measles cases and deaths is estimated to be more than 10 times higher. The wave of measles outbreaks comes as a result of increasing pockets of unvaccinated children and adolescents. The outbreaks in African countries ― including Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe ― together with the continued high numbers of measles deaths occurring in India, threaten the contribution of measles mortality reduction to the achievement of MDG4.

Moreover, the lack of political commitment to conduct high quality measles campaigns in several critical countries, combined with competing health priorities and insufficient financial support to reach underserved communities, will result in resurgence of measles and will place the recent gains in reducing measles mortality at risk.

Validating maternal and neonatal tetanus elimination

Maternal and neonatal tetanus kills tens of thousands of newborns each year, most of them in developing countries. Yet, tetanus is preventable through hygienic birth practices and immunization of women of childbearing age with tetanus toxoid vaccine.

By the end of 2010, 19 out of the 58 countries where maternal and neonatal tetanus persist as public health problems had achieved elimination.

Fifteen Indian states ― which accounts for approximately half of the country's population ― and two regions in Indonesia were also validated as having eliminated maternal and neonatal tetanus. This progress is due to the increase in use of tetanus vaccines in the routine immunization programme; the implementation of tetanus immunization campaigns to increase protection levels among women of reproductive age living in high-risk areas; and better use of skilled birth attendants. Sustaining elimination will require improvements in health service infrastructures and universal access to health services.

Progress towards eradicating polio

The picture of global polio eradication in 2010 is dominated by three strong results: a 95% reduction in the number of children paralysed by polio in India and Nigeria, the lowest levels of wild poliovirus type 3 (WPV3) in history, and the interruption of imported wild polioviruses in all 15 countries which had been re-infected in 2009. Taken together, these results show that "every last child" can be reached and immunized, even in the most difficult terrain, among the poorest, most underserved populations. And it shows that, when fully implemented, the Global Polio Eradication Initiative (GPEI) Strategic Plan 2010-2012 works.

The situation in India and Nigeria is a testament to the impact of bivalent oral polio vaccine (bOPV). Perhaps most critically, the epidemiological picture in these two countries has far-reaching implications. India and Nigeria have repeatedly been the two biggest exporters of poliovirus in recent history, and now have the lowest levels of polio transmission in their history; in India the number of genetic transmission chains of WPV1 has been reduced from nine in 2006 to one; and in Nigeria, WPV1 chains of transmission have fallen from 31 in 2008 to three. Small but persistent outbreaks in parts of each country leave no place for complacency. If these countries can take the final step and stop transmission, this achievement not only halves the number of remaining endemic countries, it eliminates the two greatest exporters of polio globally.

Meanwhile, as polio lost ground in India and Nigeria, it tightened its grip over Pakistan. In 2010, Pakistan had more cases of polio than the other three endemic countries combined. Similarly, Angola, Chad and the Democratic Republic of the Congo struggled with persistent transmission throughout the year, and large outbreaks were seen in the Republic of the Congo and Tajikistan. These outbreaks serve as a reminder that no country will be safe from polio until the virus is completely eradicated.

However, the world has been given a new set of tools to finish the job. Success is on the doorstep if the new Strategic Plan can be fully financed and implemented. Success would not only mean a polio-free world for future generations but would lead to savings of US$ 40-50 billion.